Short-term Insulin: Long-term Results for Type 2 Diabetes

Insulin has usually been the last resort for those of us who have type 2 diabetes. “If you don’t shape up, I’m going to make you inject insulin,” is a threat we may hear from our doctors.

When all else fails and our blood sugar is still too high after trying the pills for diabetes, many of us go on insulin, although usually with reluctance. But by that time most of the beta cells of our pancreas that store and release insulin into the bloodstream have also failed.

Ongoing research at Toronto’s Mount Sinai Hospital suggests that we’ve got it backwards. When people with type 2 diabetes take insulin for a short term soon after their diagnosis, it can have long-term effects.

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Last month the journal Diabetes Care published a study by the Mount Sinai research group that showed how short-term intensive insulin therapy can reduce glycemic variability. Only the abstract is online, but my friend and colleague, Dr. Bill Quick, kindly sent me a copy of the full text.

A higher level of glycemic variability may increase the risk of dangerously low blood sugar in the short term and of diabetes complications in the long term. Insulin reduced the variability of more than half of the 61 participants between the first and last week of a four-week study.

Earlier reports by this research group showed that intensive insulin treatment for two to three weeks can keep the remaining beta cells functioning for up to two years and in some cases for even longer. The Toronto team published four articles in the past two years in leading journals describing how their study of this therapy is developing.

Lead by Dr. Ravi Retnakaran, an endocrinologist at Mount Sinai’s Leadership Sinai Centre for Diabetes, the team has begun to demonstrate that when introduced early in the course of diabetes, treatment with short-term insulin therapy for two to three weeks can restore the body’s ability to make and use insulin. These are the two key problems that cause type 2 diabetes.

The treatment doesn’t work for everyone, and so far at least only few people have kept their diabetes in remission for more than two years. Not surprisingly, people who at the start of their treatment who have lower fasting blood sugar levels are more likely to achieve remission of their diabetes than people with higher levels. But surprisingly, those who had a higher body-mass index were more likely to get remission. After one year about 46 percent of all of the people studied were still in remission; after two years the proportion was 42 percent.

“Traditionally, by the time the patient is prescribed insulin therapy to treat diabetes, it’s too late to reverse the disease process,” Dr. Retnakaran says. “When we treat patients temporarily with intensive insulin therapy for three weeks early in the course of disease, it is possible to improve the ability of the body to make and use its own insulin.”

He hopes that his group’s studies will encourage the medical community to use this new strategy "to potentially reverse type 2 diabetes in its early stages.” If that were permanent, it would be huge news. But even a one or two year holiday from high blood sugar that intensive insulin therapy already offers would greatly improve the quality of life for many of us.